An annual survey by the Institute for Medicaid Innovation (IMI) found that the use of value-based purchasing among Medicaid health plans has steadily declined, falling from 92 percent of plans in 2017 to 75 percent of plans in 2020.
Now in its fourth year, the survey offers an overview of trends in Medicaid managed care, including how they have pivoted to address member needs during the pandemic. For example, 95 percent of Medicaid health plans committed to transition to telehealth in 2020 as the pandemic eliminated or greatly curtailed face-to-face medical appointments, with 70 percent of health plans paying healthcare providers the same rate for telehealth and in-person services. A large majority of Medicaid health plans (85 percent) expanded coverage to new services during the pandemic, such as remote behavioral health services and emergency food distribution.
Noting the decline in value-based purchasing arrangements, Jennifer Moore, Ph.D., R.N., founding executive director of IMI, said that Medicaid health plans identified several barriers to value-based purchasing, including provider readiness and willingness (94 percent); difficulty reporting data to providers (83 percent); Medicaid payment rates (67 percent); IT system preparedness (50 percent); and difficulties tracking quality metrics and reporting them (50 percent). “Barriers can be viewed as a roadmap for policymakers to implement changes that will sustain and expand value-based purchasing,” she said in a Nov. 19 online presentation about the survey report.
Moore added that the data from the survey demonstrate that there is an urgent need for policymakers to consider opportunities to ensure that new Medicaid initiatives are able to continue long term. “For instance, traditional funding structures do not necessarily support new initiatives launched during the pandemic, like telehealth and social needs programming,” she said. “Reimbursement policies will need to be updated to support telehealth and social needs programming after the pandemic.”
Medicaid health plans identified communication as a top challenge in nearly every survey area, Moore said. The ability to contact members and members’ willingness to engage were the top two barriers for high-risk care coordination across all survey years, reported at 100 percent and 90 percent of respondents, respectively, in 2020.
A majority of health plans identified data sharing with care managers as an obstacle to delivering behavioral healthcare, Moore said. Current policies limit the ability to share substance use treatment information, creating barriers for a large majority of health plans. And a majority of health plans at 72 percent cited lack of communication between providers and families as a common barrier to serving children with special healthcare needs.
Over half of respondents use an internally developed social determinants of health screening tool, Moore said, whereas a standardized industrywide validate tool could facilitate communication and program implementation. “Survey respondents identify that strengthening data sharing and communications is key to future health plan success.
During a panel discussion of the survey report, Katrina Miller Parish, M.D., LA Care Health Plan’s chief quality and information executive, spoke about the report’s value to her organization, which is the largest public health plan in the country, serving 2.5 million members across more than 4,000 square miles.
“From the health plan perspective, and particularly from a California health plan perspective, sometimes we can feel kind of lost in the morass of regulatory, contractual and accreditation requirements,” Miller Parish said. “We've got so many reporting and audit requirements, and you want to make sure that you're doing the right things, and putting resources in the right places to make sure that you're the best stewards of those public funds. We can find out what's going on in the state, but we don't always get that perspective from a national standpoint. With this report, we are able to say, ‘Okay, how do we compare on care management, our value-based program, our equity programs? A we focusing on the right things? Are we in the zone, where 30 percent of the health plans are focusing, or where 80 percent of the health plans are focusing?’ It really gives us that opportunity to contextualize what we're doing and make sure that we are focusing on the right thing.”
The panel discussion also included Dianne Hasselman, M.S.P.H., deputy executive director of the National Association of Medicaid Directors, and Denise Octavia Smith, M.B.A., C.H.W., P.N., founding executive director of the National Association of Community Health Workers (NACHW).
Hasselman said from the Medicaid director perspective, the health plans have been critical partners during the pandemic, in terms of increasing vaccination rates and implementing new benefits to serve 82 million people — many more people than 20 months ago — and supporting the provider network, which is really struggling. “In a very pragmatic way, directors and their senior leaders engaged in managed care can sit down with their teams and with the health plan leaders, and take a look at this report and see how the program in their state stacks up against these national numbers,” she said. “They meet regularly anyway to review performance, so I think this would be a wonderful tool to allow them to see where their state is in comparison to their peers.”
The report reveals to NACHW the accomplishments that were made with Medicaid health plans, as well as some future opportunities for community health workers [CHWs] and community-led CHW organizations to partner and strengthen the advancements that have been made during the pandemic, said Smith. “This is a time when states are working with their federal partners and funders to talk about CHWs and community-based roles and sustainability in Medicaid. The report confirms a commitment and a momentum among the health plans to move upstream to bridge the need for robust maternal and child health services, the need to engage deeply and authentically with members,” she added. “I feel like we've learned a ton about what those barriers and opportunities are to strengthen communication and engagement. It's also revealed some of those challenges and opportunities around technology and data sharing with community-based organizations. I'm really excited about the opportunity to sustain transformation and how this will impact all individuals receiving Medicaid services.”
